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Hypertension in the Kidney Transplant Recipient

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Kidney Transplantation

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Abstract

Arterial hypertension is common both before and after kidney transplantation. Uncontrolled hypertension is an important non-immunological factor that contributes to shortened patient and allograft survivals. Elevated arterial blood pressure is also an important risk factor for cardiovascular morbidity and mortality in kidney transplant recipients. Unfortunately, arterial blood pressure often remains poorly controlled following kidney transplantation. Some antihypertensive drugs interact with immunosuppressive medications and adversely affect electrolyte balance and kidney function which further complicates the management of kidney transplant patients. Recent guidelines have suggested target blood pressure goals in kidney transplant recipients that differ according to the method of blood pressure measurement (but patient-oriented management plan is still lacking). Understanding the basic mechanisms responsible for the persistent hypertension following kidney transplantation is helpful in drafting specific patient-directed management plans that include both pharmacological and non-pharmacological interventions to achieve target blood pressure control. In this chapter we propose a stepwise treatment plan that addresses hypertension both in the early and late post-transplant periods bearing in mind complications of antihypertensive medications, interactions with immunosuppressive medications, patient comorbidities, and patient-specific cardiovascular risk factors in the post-transplant period.

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Authors and Affiliations

  1. Department of Transplantation, Mayo Clinic College of Medicine, 4500 San Pablo Road, Jacksonville, FL, 32224, USA

    Hani M. Wadei M.D.

  2. Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN, 55905, USA

    Stephen C. Textor M.D.

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  1. Hani M. Wadei M.D.
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Correspondence to Hani M. Wadei M.D. .

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  1. Department of Nephrology, University of Maryland, Baltimore, Maryland, USA

    Matthew R. Weir

  2. Department of Medicine, Section of Nephrology, University of Illinois, Berwyn, Illinois, USA

    Edgar V. Lerma

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Wadei, H.M., Textor, S.C. (2014). Hypertension in the Kidney Transplant Recipient. In: Weir, M., Lerma, E. (eds) Kidney Transplantation. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-0342-9_20

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